PICOS scoping and the search strategy that follows
Nothing in a payer review matters more than getting the PICOS frame right, because it governs the search, the inclusion criteria, and ultimately the credibility of the whole submission. A frame drawn too narrowly misses relevant comparators and invites a rejection for incomplete evidence; drawn too broadly, it buries reviewers in irrelevant records and inflates cost. We fix the population, intervention, comparators, outcomes, and study designs against the anticipated appraisal scope, then translate that frame into a reproducible search.
A defensible market access literature review searches beyond a single database. We cover MEDLINE and Embase as standard, add the Cochrane Library for trials and reviews, and include economic and HTA-specific sources such as the databases maintained by HTA agencies and the grey literature that payers know to look for. Conference abstracts and trial registries are searched to reduce reporting bias, which agencies specifically probe. The search strings, database coverage, and dates are all documented so the review can be re-run and audited. Teams that want the search built and peer-reviewed as a standalone deliverable can commission our literature search strategy service and hand the validated strings to their internal analysts.
Head-to-head trials against every relevant comparator rarely exist, yet payers still need comparative effectiveness. This is where indirect treatment comparison (ITC) and network meta-analysis (NMA) become central to the submission.
When trials share a common comparator, a Bucher indirect treatment comparison (ITC) or a Bayesian network meta-analysis (NMA) can estimate relative effects across a connected evidence network. When populations differ enough that simple anchored comparisons are biased, population-adjusted methods such as matching-adjusted indirect comparison and simulated treatment comparison come into play. Choosing the right method is a methodological judgement, not a default, and it depends on network geometry, effect-measure consistency, and the availability of individual patient data.
We assess network feasibility before promising a pooled estimate, test the homogeneity and consistency assumptions that agencies scrutinise, and report uncertainty honestly. Our evidence synthesis service coordinates the SLR and the comparison so the network is built from the same locked evidence base as the clinical review, and our biostatistics team runs the Bayesian models and sensitivity analyses that underpin a credible comparative-effectiveness claim.
Not every market access question warrants a full systematic review, and pretending otherwise wastes budget and time. A targeted literature review applies a focused, transparent, but pragmatically bounded search to answer a narrower question quickly, for example an early landscape scan, a feasibility check before committing to a full programme, or an update of a specific parameter. A full systematic literature review (SLR) applies the complete, protocol-driven, exhaustive process required when the output must anchor a formal submission.
The right choice depends on the decision at stake, the deadline, and the level of scrutiny the output will face. We recommend a targeted literature review for exploratory and internal decisions and reserve the full SLR for submission-grade deliverables, and we say so plainly at scoping rather than overselling the larger engagement. Where a targeted review later needs to become a full review, we design the earlier work so it can be extended rather than repeated.
Reporting, quality appraisal, and guidance alignment
A payer-facing review earns trust through its methods documentation. We report to PRISMA standards, including the flow diagram and item-level checklist that agencies expect. Critical appraisal uses AMSTAR 2 for reviews and validated risk-of-bias instruments for the underlying studies, including the Cochrane Risk of Bias 2 tool for randomised trials and ROBINS-I for non-randomised studies. Where certainty of evidence must be graded, we apply GRADE.
The methodological backbone follows the Cochrane Handbook for systematic review conduct and the guidance from the Centre for Reviews and Dissemination (CRD), which agencies recognise as authoritative for reviews that inform decision-making. Aligning to these references is not box-ticking; it is what lets a payer methods team accept the review without re-doing it. Every appraisal judgement is recorded with its rationale so the audit trail is complete.
The output is built to slot directly into your submission architecture. Typical deliverables include the locked protocol, the reproducible search documentation, the PRISMA flow diagram, the full extraction tables, the appraisal ratings, the narrative synthesis, and, where relevant, the quantitative comparison and its sensitivity analyses. These components populate the clinical and economic sections of a global value dossier or an Academy of Managed Care Pharmacy (AMCP dossier), and map cleanly to the clinical and cost-effectiveness chapters of an HTA submission.
We provide the review in formats your writers and modellers can use, including structured extraction files rather than static tables alone, so parameters flow into the economic model without manual re-keying. The aim is a coherent evidence layer that your dossier team, your modellers, and your regulatory writers all draw from the same source.
Confidentiality, purchase orders, and named methodologist
Institutional work runs on written terms. Engagements proceed under a defined scope of work with a named methodologist, in this case Dr. Kwame Asante (PhD Health Systems) leading review methodology. We work under non-disclosure agreements as standard for pre-launch and commercially sensitive programmes, accept purchase orders from manufacturers, consultancies, and HEOR teams, and keep unpublished data and pipeline details strictly confidential.
Whether you are a manufacturer preparing a first submission, a consultancy delivering to a client, or an in-house HEOR function scaling review capacity, we structure the engagement around your deadlines and your governance requirements. To begin, share the indication, the target agencies, and the timeline, and we will return a scoped proposal. You can request a scoped quote with those details and we will map the right combination of clinical, economic, and humanistic reviews to your submission.
